• The NYSOH System contains the confidential information of individuals, including Protected Health Information ("PHI"), Federal Tax Information ("FTI"), and Medicaid Confidential Data. Medicaid Confidential Data includes, but is not limited to the names and addresses of medical assistance ("Medicaid") applicants and recipients; medical data; income eligibility and amount of Medicaid payment; and the NYS Department of Health's evaluation of such information for the purposes of determining eligibility for Medicaid. Each element of Medicaid Confidential Data is confidential.
• The NYSOH System is for official government use only. As an authorized user of the NYSOH System, I will at all times keep the data and information from the System in confidence and not disclose or reveal such data or information to others.
• I may only access confidential information on the NYSOH System if access to the information is necessary.
• I will fully and promptly report to Customer Service of the exchange any suspected loss of confidential information, including any attempted or successful unauthorized access, use, disclosure, modification or destruction of information and/or interference with system operations, including suspected virus activity. I will fully and promptly report any security problems or password compromises. I will NOT under any circumstances share my USER ID or password or any other authentication mechanism, and will not store such information in any place that is easily accessible to others. Sharing of USER IDs, passwords or other individual credentials is grounds for terminating system access.
• If my access to the NYSOH System is revoked for any reason I will NOT attempt to access the NYSOH System or information from the system. Any attempt to access the NYSOH System after System authorization is revoked will be treated as an unauthorized attempt to access a government information system.
• Unauthorized use of the NYSOH System is prohibited and subject to criminal and civil sanctions, including but not limited to those outlined in Title 26 of the United States Code, Sections 7213 7213A and 7431; Title 18 of the New York Code of Rules and Regulations; the NYS Social Services Law; and NYS Public Health Law. Penalties for misuse of Federal Tax Information or Medicaid recipient data may include, but are not limited to, fines of up to $5000 and/or imprisonment for up to 5 years.
• Offenses involving computers are also covered under New York State Penal Law, Article 156, which makes certain types of computer crimes punishable as Class C felonies.
• Because written guidance cannot cover every contingency, I agree to use my best judgment and highest ethical standards with respect to my access to the NYSOH System.

• I understand the Marketplace will keep my information private as required by law. My answers on this form will only be used to determine eligibility for health coverage.
• I understand the Marketplace may use data sources, including Experian and/or the New York State Department of Motor Vehicles, to verify my identity.
• I understand that to protect my privacy, I will need to complete Identity Verification successfully, before requesting access to the selected activity.

Identity Proofing

With respect to identity proofing, below are a few items to keep in mind.

• Ensure that you have entered your legal name, current home address, primary phone number, date of birth and email address correctly. The Marketplace will only collect personal information to verify your identity with Experian, an external identity verification provider.
• Identity Verification involves Experian using information from your consumer report profile to help confirm your identity. As a result, you may see an entry called a "soft inquiry" on your Experian consumer report. Soft inquiries are only visible to you, will never be presented to third parties, and do not affect your credit score. The soft inquiry will be titled "CMS Proofing Services" and will be removed from your Experian consumer report after 25 months.
• You may need to have access to your personal and consumer report information, as the Experian application will pose questions to you, based on data in their files. For additional information, please see the Experian Consumer Assistance website - http://www.experian.com/help/.